Calling In Sick: Dealing With Mental Illness At Work, Part 2

**VivaLasViejas**, ASN, RN

If you are a nurse who suffers from a serious mental illness such as bipolar disorder or schizophrenia, you probably have had difficulties in obtaining, and then keeping a job. Many of us have spotty work histories filled with multiple jobs where we stayed only a brief time (AKA job-hopping) and jobs we've lost because of inconsistent performance or poor attendance. Others have spent time on disability due to severe MI that kept them from working for months or even years; once stabilized, they become bored and restless, and decide that it's time to go back to work.

Obviously, there are going to be some gaps in your employment history that you'd just as soon not have to explain. Say you've been inpatient and then had to follow up with intensive outpatient treatment, or you left your last job without notice, and/or you took a few months off to heal. Now you want (and need) to get back into the working world, but first, you have to figure out your next career move.

It's only natural to have reservations about this process. You've heard the horror stories about interviewing and being asked questions that you'd rather not answer; you've heard stories about nurses who had to supply a health history and med list to Employee Health. How do you dance around these delicate situations without either telling the honest truth, or furnishing false information that will get you fired if it's ever discovered?

Though there are no foolproof methods, here are a few pointers for interviews.

One of the most common questions asked of applicants with gaps in employment is, of course, why you left the previous job and what you did during your hiatus. This can be hard to explain when you had a nervous breakdown and then spent some time in the psych unit getting straightened out.

One way to handle this is to say you left to care for someone close (not your frail, elderly grandmother---everyone has one of those!) who suddenly became acutely ill; the prospective employer doesn't have to know that the person who needed the care was YOU. Be sparing with details; for one thing, the interviewer really doesn't care, and for another, you don't want to tell a story so elaborate that you'll forget some small thing and expose your truth-stretching to the light of day. OR---you can say that you yourself were ill, but that you were treated and the problem no longer exists. They don't need to know what kind of illness you had, and in fact have no right to know. That is personal health information protected by HIPAA.

Which leads to another critical matter of concern: the dreaded employee "physical". This is something I personally have never had to undergo, with the exception of the urine drug screen and TB testing. But it's a common enough requirement to present a problem for the nurse with a mental health history that s/he would rather not share with an employer.

Hopefully, you'll have done your homework and applied at a facility which doesn't ask for PHI. Talk to people who work there, ask them how they like working for this company, and casually ask them what is involved in the hiring process. If they tell you they had to supply their health information and a med list, you may want to bypass that company and apply somewhere else; but if your employment options are limited, you may have little choice but to proceed with the application.

If/when you are faced with disclosing your medical history and/or furnishing a med list to employee health, ASK why that information is needed, what it is to be used for, and who may have access to it. In good facilities, only the employee health and infection control nurses can see your information; managers and company officers have no authority to access it, and they can even face sanctions for attempting to view it.

Remember, we do not give up our right to privacy when we become healthcare professionals! Insist upon complete confidentiality when providing your PHI to anyone outside your doctor's office. If it cannot be guaranteed, you're better off looking elsewhere, even if you have to commute.

So why all the secrecy? Why not tell a prospective employer, your boss, or your co-workers about your mental health condition? You know it's not your fault, nor is it a moral failing. You do everything you can to manage it, including taking your medication and seeing your doctor regularly---what is there to be ashamed of? Why must you hide it?

Short answer: you don't, if you're lucky enough to work in an environment that's nurturing and accepting, like my current workplace. Unfortunately, however, most are NOT like that, and nurses who disclose a psychiatric diagnosis---whether voluntarily or through an exacerbation of their illness---all too often find themselves unemployed in some fashion. Even if they remain on the job, they are all too often passed over for promotions and discriminated against in other, more subtle ways, such as being left out of committees and disciplined for mistakes that other nurses get away with routinely.

Ultimately, it's up to the individual as to when, how, and whether to disclose a mental illness that may affect them at work. Now I'd like to invite you, the membership, to share how you have handled these issues, both now and in the past, as well as to offer suggestions to other nurses who are struggling.

To be continued.....

Calling In Sick: Dealing With Mental Illness At Work, Part 2

About VivaLasViejas, ASN, RN

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